Director of Clinical and Business Development

Wedgwood Christian Services

Anthony Muller MA, LPC, CAADC

Change What Creates It

Response to treatment in the first few sessions is highly predictive of the eventual outcome.

Common Therapeutic Factors

TechniqueExpectancy

Relationship

Client Strengths

Motivational Readiness Therapeutic Alliance

Relationship Factors

Affective Relationship Clients’ Capacity to Work in Counseling

Purposefully Therapist’s Empathetic Understanding and

Involvement Client-Therapist Agreement in the Goals and

Tasks True Change Partnership

Therapeutic Alliance

“Within the client is a theory of change waiting for discovery, a framework for intervention to be unfolded and accommodated for a successful outcome”.

Hubble, Duncan, Miller, 1999

Hope and Expectancy

Possibility Focus

Therapist Expectancy

Know Your Role

Stages of Substance Use

Developmental Psychology

The study of how things change and stay the same over time.

Macro Theories of Major Struggles, Events, Cognitions and Developments applicable to almost all adolescents.

Adolescence: Biosocial Development

•Puberty

Length of time for average adult to become physically dependent on alcohol 7-14 years

Length of time for average adolescent to become physically dependent on drugs or alcohol

9-18 months

Adolescence: Cognitive Development

Adolescent Egocentrism Characteristic of adolescent thinking that

sometimes leads young people to focus on themselves to the exclusion of others and to believe that their thoughts feelings and experiences are unique

Invincibility fable Adolescents feel they are immune to the laws of

mortality and probability (and nature) Take all kinds of risks

Personal fable Adolescents imagine their own lives as mythical or

heroic See themselves destined for fame or fortune

Imaginary audience Adolescents fantasize about how others will react

(opinions of onlookers) Assume everyone else judges appearance(s) Not at ease with social world

Adolescence is a time for personal decisions and independent choices with far-reaching consequences

Because adolescents think about possibilities, not practicalities, few adolescents decide important matters rationally

Egocentrism and intuitive thinking makes it hard to analyze and plan ahead

Adolescent Decision Making

Identity Status

Erikson’s Developmental Stages – Review of Past Stages

Adolescent stage struggle is identity versus role confusion

Identity achievement = attainment of identity: self-understanding in accord with past experiences and future plans Willing to reconsider values and goals of parents

and culture, accepting some, rejecting others.

Adolescent Development

Cognitive Problem Solving Hypothesize Inspect Data

Identity & Personality Many Theories Erickson’s

Developmental Theory Identify vs Confusion

Emotional Tasks Needed For “Recovery” Self Manage Stress Identification of Feelings Sort Current Feelings Expressing & Managing Feelings Delayed Gratification Impulse Control

Emotional Intelligence Pt -1

•Integrated From Daniel Goleman’s Emotional Intelligence

Most Substance Abusing or Dependent Adolescents are Behind in Emotional Development.

For Treatment to be Successful we Must Address and Build Skills to Complete the Emotional Tasks

Emotional Intelligence Pt -2

Heart Attacks Follow Doctors Orders? 40% Diabetes Follow Doctors Orders? 35% Drug and Alcohol Abuse/Dependent Who

Make Significant Change? 35%

Why Focus On Change

Change Model Trans Theoretical Model Focuses on Internal Motivation Provides a Treatment “Compass” Concept of “Sequencing Treatment”

Why Stages of Change

Pre-ContemplationNot Ready To Change

Description May see behavior as

posing some problems but not as a problem.

No serious consideration of or desire to change.

Not aware or denying consequences associated with the behavior

Reason For Contact - Mindset

Pressure From Others Proving to others he/she does not have a

problem Court or Legal Referral

Pre-ContemplationNot Ready To Change

ContemplationThinking About Change

Description Serious consideration

to modify behavior Mostly considers

behavior to be a problem

Trying to understand problem

Not yet decided to change

Reason For Contact - Mindset

To Understand Problem or Get Information To Manage Family Problems To Manage Associated Problems

ContemplationThinking About Change

PreparationGetting Ready To Make A Change

Description Has Decided to commit to

Change Willing to make efforts/pay

the price Ready to Take

Responsibility For Change in Behavior

Not Yet Fully Implemented Plan to Change

ActionReady To Make A Change

Description Taking Significant Action

on Own or with Professional Help to Modify Problem

Implement Plan As Long As Active

Attempts With Some Success Are Being Made With Some Success

MaintenanceContinuing To Support Behavior

Change

Description After Some Period of

Active Change, the Individual has Demonstrated Some Ability to Cease or Control the problem

For Research Purposes Generally 6 Months

Pre-ContemplationNot Ready To Change

Tasks Consciousness

Raising- Education and Feedback

Environmental Reevaluation

Reinforcement Management

Social Liberation

In English Intervention-provide

info and personalized feedback, increase perception of risks and problems, discuss possibility of change.

Contemplation Thinking About Change

Tasks Self-Reevaluation Environmental

Reevaluation Consciousness

Raising Helping Relationship Dramatic Relief

In English Intervention - tip

balance in favor of change, elicit reasons for change and risks of not changing, increase confidence

PreparationGetting Ready To Make A Change

Tasks Self Liberation Self Reevaluation Helping Relationship Social Liberation Environmental

Reevaluation Dramatic Relief

In English Intervention -

Strengthen commitment, find a change strategy that is acceptable, accessible and effective

ActionReady To Make A Change

Tasks Counter-Conditioning Stimulus Control Helping Relationships Self Liberation Reinforcement

Management

In English Intervention - Affirm

commitment, identify steps, identify resources, check adequacy of plan, skills and preparation

MaintenanceContinuing To Support Behavior

Change

Tasks Counter-

Conditioning Stimulus Control Reinforcement

Management Self-Liberation

In English Intervention - affirm

commitment, focus on positive benefits noticed, identifying tempting situations, develop relapse prevention plans

Most Utilized Approach In AOD Treatment. Oldest Of All Major Treatment Approaches Focus of Support and Self Reflection With Recent Professionalism Of Field Many See

As A Valuable Support But Not As “A” Or “The” Only Primary Approach To Treatment.

Self Help - 12 Step Approach

Self Help - 12 Step ApproachFor Adolescent Treatment

PRO’S

Easy Model to Follow Broad Reaching

Support Focus on Immediate Positive Culture

CON’S

Developmental Challenges

Motivation Levels Immediate Strain on

Relationship Not Person Centered

or Holistic

Crux of a Medical Model approach 1956 AMA - “The Disease” Most commonly generalized to all

“addictions” Focus - It’s not your fault, It is your

responsibility

Disease Concept

Disease ConceptFor Adolescent Treatment

PRO’S

Medically Endorsed Use Has Serious

Effects PPCF Three - Interrelated

Factors

CON’S

If You Are In Treatment You Have The Disease

Genetic Link Only Established For Alcohol

Forever Focus

Six Stage Objective Process of “Recovery” Comprehensive Linear Model Holistic Life Change Not Just Behavioral

Marker of Non-Use Core Concept Of Process Focus - Progressive Life Style Change Moving

From Using Lifestyle To Sobriety

Developmental Model of Recovery

Developmental Model Recovery

For Adolescent Treatment PRO’S

Progressive Objective Markers More Than One

Behavior Answers Tough Topic

Of Glamorization and Euphoric Recall

CON’S

Behavioral Markers - Where To Go, Not How To Get There

“Dependent” Focus

Stages of Substance Use Holistic Assessment - (Functional) Family Assessment Focus - Altogether a complete treatment

model. Sees adolescent treatment as different. Thorough assessment, LOC recommendation, strength based treatment plan, holistic treatment12 step oriented.

Nowinski’s Model

Functional Assessment

Education Life Skills LEISURE COPING Emotions Self Esteem Spirituality

Cognitive, Literacy, Grade + Future

Communication + Assertiveness Meaningful Fun, Peer Group Stress,Anger, Loss,

Disappointment Pendulum of Happiness to Anger Self Perception, Future Options Personal Values and Ethics

Nowinski’s ModelAdolescent Considerations

PRO’S

Stages of Substance Use

Functional Assessment Strengths Based Adolescent Counselor

Mindset

CON’S

Treats All as Addicts LOC Tied With Stages Focus on Denial not

Person

Medical Marijuana

Tweeners

SYNTHETIC MARIJUANA

WHAT IS IT?

Commonly referred to as K2 or SPICE. It is a dried blend of herbs and spices that is

sprayed with a synthetic chemical. When consumed, K2 or Spice mimics the effects

of Marijuana.

SYNTHETIC MARIJUANA

K2 is sold as incense or potpourri and is commonly purchased in tobacco shops, head shops, gas stations, convenience stores and over the Internet.

It is often marketed as incense or “fake weed.”

It is important for parents to realize that K2 is not illegal in every state so it is easily accessible for purchase over the Internet.

Synthetic marijuana

SYNTHETIC MARIJUANA

Common street names:

Spice Spice Gold Spice Silver Spice Diamond Fire & Ice Demon Genie

SYNTHETIC MARIJUANA

IT IS OFTEN LABELED AS “POTPOURRII”

AND “NOT FOR HUMAN CONSUMPTION”

Synthetic marijuana

PUBLIC HEALTH OFFICIALS ACROSS THE COUNTRY HAVE NOTED THE INTENSE EFFECTS OF SYNTHETIC MARIJUANA.

SOME HAVE FOUND THAT THE CHEMICALS USED IN THE MANUFACTURING OF SYNTHETIC MARIJUANA CAN CAUSE IT’S EFFECTS TO BE 10 TIMES MORE POTENT THAN MARIJUANA.

IN LARGE DOSES, SYNTHETIC MARIJUANA CAN CAUSE SEVERE HALLUCINATIONS AND DISORIENTATION THAT CAN LAST FOR DAYS.

SYNTHETIC MARIJUANA

WHY IS IT SO POPULAR?

IT IS SEEN AS A “SAFE” ALTERNATIVE TO MARIJUANA BY TEEN AGERS

IT IS EASY TO BUY IT IS UNTRACEABLE IN DRUG SCREENS WITH IN

TWO HOURS OF USE.

Synthetic marijuana

REPORTED SIDE EFFECTS: Soaring heart rates Respiratory issues Panic attacks Paranoia, Hallucinations Delusions Vomiting Increased Agitation

Why Kids Use It

1. To Avoid Detection Already have Abuse or Addiction Already have consequences

2. Alcohol and Marijuana Aren’t Enough Tolerance has Developed Tweener Drug

3. Think its Safe and Like Marijuana Curious Misinformed

Managing Resistance

Categories of Resistant Behavior Arguing Interrupting Denying Ignoring

(Miller and Rollnick 1991)

Resistant Behaviors

Arguing: Challenging Discounting Hostility

Interrupting Talking Over Cutting Off(Miller and Rollnick 1991)

Resistant Behaviors (cont)

Denying Blaming Disagreeing Excusing Claiming Impunity Minimizing Pessimism Reluctance Unwillingness to change(Miller and Rollnick 1991)

Resistant Behaviors (cont)

Ignoring Inattention Non-answer No response Side tracking(Miller and Rollnick 1991)

Strategies for Dealing with Resistant Behaviors

Simple Reflection:Respond with “non-resistance” A simple

acknowledgement of the client’s disagreement, emotion, or perception. This can permit further exploration rather than defensiveness.

Amplified Reflection:Reflect back what client has said in an exaggerated

or amplified form. Do not use a sarcastic tone.(Miller and Rollnick 1991)

Strategies for Dealing with Resistant Behaviors, (cont)

Double Sided reflection: Acknowledge what the client has said, and add to it

the other side of the client’s ambivalence. Example: “You can see some real problems, but you are not willing to think about quitting altogether.

Shifting Focus: Shift the client’s attention away from what seems to

be a stumbling block in the way of progress.(Miller and Rollnick 1991)

Strategies for Dealing with Resistant Behaviors, (cont)

Agreement with a twist: Offer initial agreement, but with a slight twist or

change of direction. A reflection followed by a reframe. Example: “You’ve got a good point there, there is a bigger picture, drinking problems like these do involve the whole family.”

Emphasizing personal choice and control: Example: “It really is up to you to decide to change. No one can make this decision for you. No one can

make you change.” Etc. Very important when person feels their freedom has been infringed upon. (Miller and Rollnick 1991)

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